Diagnostic radiology has experienced a 44% Medicare reimbursement reduction over the past 10 years. Medicare reimbursements for diagnostic radiology began declining with the passage of the Deficit Reduction Act (DRA) of 2006.
Recent research led by Derrek Schartz, MD of the Department of Imaging Sciences at the University of Rochester, showed that adjusting for inflation and looking at the 50 most routine imaging exams, diagnostic radiology faces a “troublesome” trend, which indicates the need for payment reform.
Their research examined reimbursement data from the Centers for Medicare & Medicaid Services (CMS) between 2011 and 2021. Many essential diagnostic services have suffered significant reimbursement declines:
- Ultrasound guidance for biopsy — down 75%
- DEXA bone axial — down 66.2%
- MRI of the brain without contrast — down 64.1%
Just three services saw an increase in reimbursement over the 10-year study period.
- Abdomen — up 2.5%
- Hip — 3.3%
- Femur — 6%
Only one year saw an increase in Medicare reimbursements for diagnostic radiology; 2016-2017 saw a 0.2% increase, while 2013-2014 experienced a 16% decline. Reimbursement for MRI suffered the most dramatic decline, down 60.6% from 2011 to 2021, with CT down 44.4% and ultrasound down by 31.3%. Radiograph reimbursement declined by 6.2%.
Average work relative value units fell by 1.3% during the same 10-year period. Almost 70% of imaging exams saw no change in wRVUS; nine experienced a reduction, and seven increased. Schartz and co-authors postulate that the constancy of wRVUs and the Medicare conversion factor may have impacted reimbursement, not reflecting inflation rates over the last decade.